In the next in our series of getting to know the people behind the Vanguard programmes I got to ask Rebecca Dobson, Community Pharmacist some questions about what its like to work in a Vanguard site, Rebecca is working to reduce medicines related hospital admissions :-
- What does being a vanguard mean to you? Looking at new ways of delivering healthcare and addressing issues within primary care with a fresh approach.
- What problem did you want to solve? How can we reduce medicines related hospital admissions and also how can we release GP time.
- How did you go about it? I initially contacted the various healthcare professionals in my area that I thought the MCP pharmacist role might impact in order to introduce myself. I then arranged to spend some time with them and so I met local GPs, practice nurses, district nurses, the community matron, the MCP community GP, the lead respiratory nurse etc. After I’d gathered a sense of where my role might sit, I then began to run clinics within local surgeries for minor ailments, medication reviews, hypertension and atrial fibrillation. This role is still in its infancy and my time is limited but the scope for home visits to vulnerable patients referred by the community team is certainly a viable next step.
- In practical terms what difference have you noticed and has the way you work on a day-to-day basis changed at all? As my role is so new it has taken some time for colleagues to understand what it is that I do and what the potential of my role could be. I have also needed to prove my skills and my worth, but now 6 months in, I am a valued member of the clinical team and have had plenty of really positive feedback from colleagues and patients alike.
- What has the reaction and what has the level of staff engagement been like? To be honest I was a little nervous about the staff engagement with my role initially as it was such a new role to everyone, including myself. However, I have experienced nothing but positivity which has been fantastic. Once the clinical team realised that I was there to do something different and not to replicate anyone else’s work then I felt that I was able to carve out my role with the support of those around me
- How would you explain the way your new care model works to members of the local community? I would say firstly that my role is not there to replace the fantastic work that the community pharmacists are already doing. However, for those that need the help of a clinical pharmacist to review their medicines, help them get the best out of their medicines and make changes where appropriate then they should come and see me. They would also be able to come and see me for the treatment of minor ailments that cannot be treated by the community pharmacist, blood pressure management and anticoagulation advice.
- What is already having or what is going to have the greatest impact and value for patients as a result? At the moment, one of the greatest impacts for patients is me releasing GP time so that the patients that really need to see their GP are able to. The patients are also really benefiting from me having longer appointment times than the GPs for medication reviews and so I am able to spend a decent amount of time with them explaining about their medicines and looking for ways to make their medicine regime easier for them to cope with.
- Do you have any great case studies that immediately spring to mind or can you tell me what your most satisfying day at work has been since becoming a vanguard? I have had lots of really positive feedback from patients and some even ask to specifically come and see me now which is such a compliment. The most satisfying interactions have been when the patient has come to me with a problem and together we have worked out a solution and then I follow them up a couple of weeks later and I’m told that the decisions I made have really improved their quality of life. This happens most often around the issue of pain management.
- What do you think has been the most difficult challenge or barrier to overcome? Some patients have been the most challenging. They come to me thinking that they have been fobbed off when they thought that they really needed to see the GP, but then I go through all the questioning and examining that the GP would have done and they realise that I’m actually more than capable of treating them. And of course, if I felt that they really needed to see the GP then I would arrange that for them.
- Vanguards are leading on developing new care models that will act as blueprints for the future of the health and care system in England. What advice would you give to anyone looking to adopt your new care model? I would advise that the MCP pharmacist needs to be a very experienced pharmacist, able to work autonomously and willing to adapt and learn at a fast pace.
- How are you sharing learning? As I am currently the only MCP pharmacist in the area, the sharing of learning has been difficult. The new Ilkeston MCP pharmacist starts in the New Year and that will provide an excellent opportunity to share learning and experiences. Up until this point my feedback and learning has mostly been through my GP colleagues.
- What do you think your vanguard and the service it delivers will look like in 12 months’ time? With enough resource this service could be impacting more patients both in clinics and in their own homes. The potential is huge, but so is the potential workload on a very small team.
- From your work so far, what’s your one top tip (or learning) that you could share right now with us that we could learn from and implement within our work areas? To do something new you have to be brave!!
If you want to find out more information about the amazing work Rebecca is doing you can contact [email protected]
NHS Arden & GEM Commissioning Support Unit has been working with vanguard sites in supporting the development and critique of their value propositions. Adopting a ‘logic model’ approach, they have combined their extensive knowledge of the NHS and local delivery dynamics with leading academic and private sector expertise. This analysis provides an invaluable assessment of the various elements involved in developing a robust new model of care www.ardengemcsu.nhs.uk